[1]程时刚 吕泽民 袁祖森 向旋 毛晓雯 林松 耿红琼 杨星海**.腹腔镜输尿管输尿管端侧吻合术在小儿重复肾中的应用[J].中国微创外科杂志,2023,01(2):135-139.
　Cheng Shigang,Lv Zemin,Yuan Zusen,et al.Laparoscopic Ureteroureterostomy in the Management of Duplex Collecting Systems in Children[J].Chinese Journal of Minimally Invasive Surgery,2023,01(2):135-139.
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腹腔镜输尿管输尿管端侧吻合术在小儿重复肾中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年2期
页码:
135-139
栏目:
短篇论著
出版日期:
2023-02-25

文章信息/Info

Title:
Laparoscopic Ureteroureterostomy in the Management of Duplex Collecting Systems in Children
作者:
程时刚 吕泽民 袁祖森 向旋 毛晓雯 林松 耿红琼 杨星海**
(华中科技大学同济医学院附属湖北妇幼保健院外科，武汉430070)
Author(s):
Cheng Shigang;  Lv Zemin;  Yuan Zusen;  et al.
Department of Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, China
关键词:
腹腔镜; 重复肾; 上半肾切除; 输尿管输尿管吻合术
Keywords:
Laparoscopy; Duplex kidney; Heminephrectomy; Ureteroureterostomy
文献标志码:
A
摘要:
目的探讨腹腔镜输尿管输尿管端侧吻合术治疗小儿重复肾的安全性和有效性。方法回顾性分析2020年6月~2021年12月9例重复肾上组肾积水行腹腔镜输尿管输尿管端侧吻合术的临床资料。年龄3个月~8岁(中位年龄7个月)。左侧6例，右侧2例，1例双侧重复肾伴左侧上组肾积水。2例术前检查提示上组肾对应输尿管异位开口于阴道或膀胱颈部，6例伴输尿管末端膨出。先行膀胱镜检查及患侧下组肾输尿管内双J管置入，于下组肾输尿管远端行腹腔镜输尿管输尿管端侧吻合。结果9例均顺利完成腹腔镜手术，无中转开放手术。术中无并发症，术中出血量<10 ml。手术时间180~240(202.2±21.1)min。住院时间7~10(8.5±0.9)d。术后4~6周拔除双J管，2例双J管留置期间尿路感染。9例术后随访6~21(11.7±5.1)月，复查超声均提示上组肾积水较前减轻，7例上组肾扩张的输尿管直径较前缩小。一例8岁女性患儿术前输尿管异位开口存在尿失禁，术后症状完全消失。结论初步经验表明腹腔镜输尿管输尿管端侧吻合术对小儿重复肾是一种安全、有效的术式选择。
Abstract:
ObjectiveTo investigate the efficacy and safety of laparoscopic ureteroureterostomy in the management of duplex collecting systems in children.MethodsA retrospective review of 9 patients who underwent laparoscopic ureteroureterostomy at our institution between June 2020 and December 2021 was performed. The age ranged from 3 months to 8 years old (median, 7 months old). There were 6 cases of leftsided and 2 cases of rightsided duplex colleting systems, and the other one patient had bilateral duplex collecting system with leftsided upper pole hydronephrosis. Two of the patients were found to have ectopic upper pole ureters draining either into the vagina or bladder neck. Ureterocele was present in 6 cases. Cystoscopy and double J stent placement into the lower pole ureter were performed at the beginning of all the cases. Laparoscopic endtoside ureteral anastomosis was carried out along the distal lower pole ureter.ResultsLaparoscopic ureteroureterostomy was completed in 9 patients without conversion to open surgery. There were no intraoperative complications and the blood loss was less than 10 ml. The operative duration was 180-240 min (mean, 202.2±21.1 min), which included the time to perform the cystoscopy and double J stent placement. The hospital stay was 7-10 d (mean, 8.6±0.9 d). The double J stents were removed after 4-6 weeks. Two children presented with febrile urinary tract infection (UTI) while still having a double J stent in place. The followup duration was 6-21 months (mean, 11.7±5.1 months). All the patients demonstrated improved hydronephrosis and 7 patients demonstrated improved ureteral dilation under ultrasound review. An eightyearold girl who presented with incontinence was completely dry.ConclusionLaparoscopic ureteroureterostomy with endtoside anastomosis is a safe and effective manner in the treatment of duplex collecting systems in children.

参考文献/References:

[1]Siomou E,Papadopoulou F,Kollios KD,et al.Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection:a study of 63 children.J Urol,2006,175(2):678-682.
[2]Deeg KH.Sonographic differential diagnosis of duplex kidneys.Ultraschall Med,2022,43(4):332-353.
[3]王锦斌，方晓亮，陈周彤，等.单根输尿管膀胱再植术与输尿管端侧吻合术治疗小儿输尿管重复畸形的疗效对比研究.临床小儿外科杂志，2022，21(4):341-346.
[4]Chacko JK,Koyle MA,Mingin GC,et al.Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication.J Urol,2007,178(4):1689-1692.
[5]Ewalt D,Glenski W,Bernier P.Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment:management by partial nephroureterectomy alone.J Urol,1995,154(2):723-726.
[6]Gerwinn T,Gnannt R,Weber DM,et al.Laparoscopic ureteroureterostomy vs. common sheath ureteral reimplantation in children with duplex kidney anomalies.Front Pediatr,2021,9:637544.
[7]Vates TS,Bukowski T,Triest J,et al.Is there a best alternative to treating the obstructed upper pole?J Urol,1996,156(2 Pt 2):744-746.
[8]González R,Piaggio L.Initial experience with laparoscopic ipsilateral ureteroureterostomy in infants and children for duplication anomalies of the urinary tract.J Urol,2007,177(6):2315-2318.
[9]殷晓鸣，许卓凡，杨屹.上位肾分肾功能＜10%重复肾患者保留或不保留上肾手术的预后比较.单中心队列研究.临床小儿外科杂志，2021,20(4):325-329.
[10]Kawal T,Srinivasan AK,Talwar R,et al.Ipsilateral ureteroureterostomy:does function of the obstructed moiety matter?J pediatr Urol,2019,15(1):50.e1-50.e6.
[11]Sheth KR,White JT,Janzen N,et al.Evaluating outcomes of differential surgical management of nonfunctioning upper pole renal moieties in duplex collecting systems.Urology,2019,123:198-203.
[12]Hagg MJ,Mourachov PV,Snyder HM,et al.The modern endoscopic approach to ureterocele.J Urol,2000,163(3):940-943.
[13]Renzo DD,Ellsworth PI,Caldamone AA,et al.Transurethral puncture for ureterocele:which factors dictate outcomes?J Urol,2010,184(4):1620-1624.
[14]Castagnetti M,Cimador M,Sergio M,et al.Transurethral incision of duplex system ureteroceles in neonates: does it increase the need for secondary surgery in intravesical and ectopic cases?BJU Int,2004,93(9):1313-1317.
[15]曹华林，周辉霞，马立飞，等.腹腔镜重建性手术治疗小儿重复肾畸形合并肾盂输尿管连接部梗阻(附5例报告).微创泌尿外科杂志,2019,8(1):7-11.
[16]Lee YS,Hah YS,Kim MJ,et al.Factors associated with complications of the ureteral stump after proximal ureteroureterostomy.J Urol,2012,188(5):1890-1894.
[17]Harms M,Haid B,Schnabel MJ,et al.Ureteroureterostomy in patients with duplex malformations:does a large diameter of the donor ureter affect the outcome?J Pediatr Urol,2019,15(6):666.e1-666.e6.
[18]McLeod DJ,Alpert SA,Ural Z,et al.Ureteroureterostomy irrespective of ureteral size or upper pole function:a single center experience.J Pediatr Urol,2014,10(4):616-619.

备注/Memo

备注/Memo:
基金项目：第二届医学领军人才工程培养对象暨湖北名医工作室(1020012401)**通讯作者，Email：xinghaiyang0719@163.com
更新日期/Last Update: 2023-05-17